Diagnosis and treatment of chronic subdural hematomas in elderly and senile age patients (own experience and current global trends)

Keywords: chronic subdural hematoma; methods of treatment; elderly and senile age.


Objective ‒ to improve the treatment of chronic subdural hematoma (CSDH) in older people.
Materials and methods. Retrospective analysis of the results of diagnosis and treatment of patients with CSDH treated in the Department of Neurotrauma of Romodanov Institute of Neurosurgery NAMS of Ukraine and Zaporizhzhya City Hospital for Emergency and Emergency Medicine in 2010–2019 was performed. The distribution by age was as follows: elderly patients – 80, patients senile age – 32, long-lived – 6. Multislice computed tomography was made in 86.7 % of patients, magnetic resonance imaging ‒ in 13.3 %. In 118 cases different types and volumes of surgical intervention were performed, in 58 ‒ conservative treatment.
Results. The indication for surgery in elderly and senile patients with CSDH is the presence of hematoma ≥100 cm3 in the absence of dislocation syndrome. Concomitant somatic diseases were revealed in 95 % of cases. Treatment efficacy was monitored by dynamic magnetic resonance imaging studies (in 73.5 % cases) and multislice computed tomography (in 26.5 %). A comprehensive clinical and neurological examination was performed according to the modified Rankine scale, the Glasgow extended consequences scale, calculation of the Barthel index, after 1, 3 and 6 months. Postoperative complications: CSDH recurrence in 10 (6.0%) patients, mostly older than 60 years, pneumocephalus ‒ in 1 (0.84 %), meningoencephalitis ‒ in 1 (0.84 %) patients. Postoperative mortality was 6.8 % (8 cases). 
Conclusions. When choosing a method of treatment should be considered etiopathogenetic factors of hematoma formation, the severity of neuroimaging characteristics of CSDH, the degree of displacement of midline structures and neurological symptoms, somatic risks and the patient’s consent. The choice of treatment tactics for the elderly and senile is based not only on the Glasgow consequences scale and Markwalder grading score, but also on the scale of A.K. Thotakura et al. (Displacement of median structures and hematoma density (on the Hounsfield scale)). Removal of the hematoma is the main method of treating CSDH, aspiration of CSDH through burr holes followed by passive drainage is the method of choice. Conservative treatment of CSDH according to clear indications can be used both alone and in combination with surgical treatment.


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Almenawer SA, Farrokhyar F, Hong C, et al. Chronic subdural hematoma management: a systematic review and meta-analysis of 34, 829 patients. Ann Surg. 2014;259(3):449-57. doi:. http://dx.doi.org/10.1097/SLA.0000000000000255

Iorio-Morin C, Blanchard J, Richer M, Mathieu D. Tranexamic Acid in Chronic Subdural Hematomas (TRACS): study protocol for a randomized controlled trial. Trials. 2016;17(1):235. doi: 10.1186/s13063-016-1358-5

Jiang R, Wang D, Poon WS, et al. Effect of Atorvastatin On Chronic subdural Hematoma (ATOCH): a study protocol for a randomized controlled trial. Trials. 2015;16(1):528. http://dx.doi.org/10.1186/s13063-015-1045-y

Miah IP, Holl DC, Peul WC, et al. Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial): study protocol for a randomised controlled trial. Trials. 2018;19(1):575. doi:10.1186/s13063-018-2945-4

Hirashima Y, Kurimoto M, Nagai S, Hori E, Origasa H, Endo S. Effect of platelet-activating factor receptor antagonist, etizolam, on resolution of chronic subdural hematoma ‒ a prospective study to investigate use as conservative therapy. Neurol Med Chir (Tokyo). 2005;45(12):621-6. http://dx.doi.org/10.2176/nmc.45.621

Neidert MC, Schmidt T, Mitova T, et al. Preoperative angiotensin converting enzyme inhibitor usage in patients with chronic subdural hematoma: Associations with initial presentation and clinical outcome. J Clin Neurosci. 2016;28:82-6. http://dx.doi.org/10.1016/j.jocn.2015.09.022.

Poon MTC, Al-Shahi Salman R. Association between antithrombotic drug use before chronic subdural haematoma and outcome after drainage: a systematic review and meta-analysis. Neurosurg Rev. 2018;41(2):439-45. doi:10.1007/s10143-017-0860-x

Lu CL, Chang SS, Wang SS, Chang FY, Lee SD. Silent peptic ulcer disease: frequency, factors leading to “silence”, and implications regarding the pathogenesis of visceral symptoms. Gastrointest Endosc. 2004;60(1):34-8. doi: 10.1016/s0016-5107(04)01311-2. PMID: 15229422.

Role of dexamethasone in the conservative treatment of chronic subdural hematoma. 2015 01.02.2016 [cited 26 Aug 2016]; Available from: https://clinicaltrials.gov/ct2/show/study/NCT02362321?term=chronic+subdural+hematoma&rank=15&sect=X370156

Thotakura AK, Marabathina NR. Nonsurgical treatment of chronic subdural hematoma with steroids. World Neurosurg. 2015;84(6):1968-72. http://dx.doi.org/10.1016/j.wneu.2015.08.044

Wilson JT, Pettigrew LE, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma. 1998;15(8):573-85. doi: 10.1089/neu.1998.15.573. PMID: 9726257.

Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg. 1981;55(3):390-6. http://dx.doi.org/10.3171/jns.1981.55.3.0390.

Wilson JL, Hareendran A, Grant M. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the Modified Rankin Scale. Stroke. 2002;33(9):2243-6.

Miah IP, Holl DC, Peul WC, et al. Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial): study protocol for a randomised controlled trial. Trials. 2018;19(1):575. doi:10.1186/s13063-018-2945-4

Pichert G, Henn V. Konservative Therapie chronischer Subduralhämatome. Schweiz Med Wochenschr. 1987;117(47):1856-62. In German. PMID: 3423774.

Brennan PM, Kolias AG, Joannides AJ, Shapey J, Marcus HJ, Gregson BA, Grover PJ, Hutchinson PJ, Coulter IC; British Neurosurgical Trainee Research Collaborative. The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg. 2017 Mar 17:1-8. doi: 10.3171/2016.8.JNS16134.test. PMID: 28306417.

Delgado-López PD, Martín-Velasco V, Castilla-Díez JM, Rodríguez-Salazar A, Galacho-Harriero AM, Fernández-Arconada O. Dexamethasone treatment in chronic subdural haematoma. Neurocirugia (Astur). 2009;20(4):346-59. http://dx.doi.org/10.1016/S1130-1473(09)70154-X.

Emich S, Richling B, McCoy MR, et al.The efficacy of dexamethasone on reduction in the reoperation rate of chronic subdural hematoma ‒ the DRESH study: straightforward study protocol for a randomized controlled trial. Trials. 2014;15(1):6. http://dx.doi.org/10.1186/1745-6215-15-6.

Glancz LJ, Poon M, Hutchinson PJ, Kolias AG, Brennan PM; British Neurosurgical Trainee Research Collaborative (BNTRC). Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma. Acta neurochirurgica, 2020;162(6):1455-66. https://doi.org/10.1007/s00701-020-04356-z

Huang J, Gao C, Dong J, Zhang J, Jiang R. Drug treatment of chronic subdural hematoma. Expert Opin Pharmacother. 2020;21(4):435-44. doi: 10.1080/14656566.2020.1713095.

Haines DE, Harkey HL, al-Mefty O. The “subdural” space: a new look at an outdated concept. Neurosurgery. 1993 Jan;32(1):111-20. doi: 10.1227/00006123-199301000-00017. PMID: 8421539.

How to Cite
Borovyk, L. (2022). Diagnosis and treatment of chronic subdural hematomas in elderly and senile age patients (own experience and current global trends). Ukrainian Interventional Neuroradiology and Surgery, 38(4), 37-49. https://doi.org/10.26683/2786-4855-2021-4(38)-37-49